PDF(Pubmed)
Abstract：
Optic neuritis is a rare presentation of vitamin B12 deficiency. We describe a 33-year-old female patient living with HIV presenting with progressive loss of vision for 1 week. She had a history of severe peripheral neuropathy that was managed with vitamin B12-containing tablets approximately three years before presenting with progressive loss of vision. On examination, she had no perception of light in the left eye and no perception of hand motion in the right eye. The fundus in her left eye had mild blurring of disc margins. Results from tests done showed a haemoglobin of 12.9g/dl, MCV 101fl, a serum vitamin B12 of 78pmol/l, and cytomegalovirus (CMV) test showed no active disease. She was diagnosed with optic neuritis and started on 30 mg tablets of prednisolone for 1 week with slight improvement. She was then started on vitamin B12 injections 1 mg daily for 10 days and thereafter, monthly for 6 months. She reported gradual improvement and regained her sight after 5 months treatment of with Vitamin B12 injections. Ophthalmic manifestations of vitamin B12 deficiency are not common and may present without haematological signs therefore, a high index of suspicion is required for early diagnosis and management of vitamin B12 deficiency.
摘要：
视神经炎是维生素B12缺乏的罕见表现。我们描述了一名33岁的HIV女性患者，其视力进行性丧失1周。她有严重的周围神经病变病史，在出现进行性视力丧失前约三年，接受含维生素B12的片剂治疗。在检查中，她对左眼的光线没有感知，对右眼的手部运动也没有感知。她左眼的眼底有轻微的椎间盘边缘模糊。测试结果显示血红蛋白为12.9g/dl，MCV101fl,血清维生素B12为78pmol/l，巨细胞病毒（CMV）检测显示无活动性疾病。她被诊断为视神经炎，开始服用30毫克的泼尼松龙片剂1周，略有改善。然后，她开始每天注射1毫克维生素B12，持续10天，每月六个月。她报告逐渐改善，并在注射维生素B12治疗5个月后恢复视力。维生素B12缺乏的眼科表现并不常见，因此可能没有血液学体征，维生素B12缺乏症的早期诊断和治疗需要高度怀疑。
